Intracardiac Echocardiography to Guide Watchman FLX Implantation

Nielsen‐Kudsk, Jens Erik; Berti, Sérgio; Caprioglio, Francesco; Ronco, Federico; Arzamendi, Dabit; Betts, Timothy R.; Tondo, Claudio; Christen, Thomas; Allocco, Dominic J.

doi:10.1016/j.jcin.2022.10.024

Cited by 23 publications

(7 citation statements)

References 13 publications

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“…The ICE LAA trial was a prospective, multicenter study that assessed the rate of peridevice leak when LAAO with the Watchman FLX device was used with intracardiac ICE. 19 This large sample of 100 patients all had technical success without clinically significant perideivce leaks on TEE follow up. 19 Standardization of ICE imaging for reproducible device deployment and assessment will be a cornerstone of procedural success as LAAO continues to become a more prevalent solution to stroke risk reduction in patients unable to tolerate long term OAC.…”

Section: Future Directionsmentioning

confidence: 87%

Left Atrial Appendage Occlusion with Intracardiac Echocardiography and Electroanatomic Mapping

Carlisle

Jackson

Thomas

et al. 2023

Preprint

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Left atrial appendage occlusion (LAAO) has emerged as an important therapy for patients with atrial fibrillation at risk for stroke who are not good candidates for long-term oral anticoagulation. Transesophageal echocardiography (TEE) has an important and foundational role in preprocedural left atrial appendage assessment, intraprocedural guidance and device deployment, and post-procedural evaluation in follow-up. Recent studies have evaluated intracardiac echocardiography (ICE) as a primary intraprocedural imaging modality without the need for TEE. The use of ICE offers promise of expedited patient care, reduced procedural complexity, and reduced costs. Observational reports of ICE for LAAO highlight significant variability in procedural technique, including but not limited to ICE catheter placement and position as well as the type and number of intracardiac views. Integration with concomitant electroanatomic mapping provides additional information to the operator regarding the orientation of the ICE catheter to the atrial geometry and can be used to optimize views and avoid perforation. It also allows for more precise near-field delineation of transseptal access. This review characterizes a standardized approach for harnessing ICE based off four anatomic views (aortic, mitral, left superior pulmonary vein, and inferior). These views optimize the unique vantage points of left atrial ICE as opposed to attempting to replicate the transesophageal windows. The focus on complementary and orthogonal angles allows for more precise device placement and assessment for device positioning and peri-device leak.

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Section: Future Directionsmentioning

confidence: 87%

Left Atrial Appendage Occlusion with Intracardiac Echocardiography and Electroanatomic Mapping

Carlisle

Jackson

Thomas

et al. 2023

Preprint

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“…Moreover, it is contraindicated in certain patients. Intracardiac echocardiography (ICE)‐guided LAAO under local anesthesia has been considered a safe and effective alternative to TEE for percutaneous LAAO 9,14,15 . However, its lower cost‐effectiveness restricts its widespread clinical use.…”

Section: Discussionmentioning

confidence: 99%

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

Ruan,

Li,

Jin

et al. 2023

Cathet Cardio Intervent

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BackgroundLeft atrial appendage occlusion (LAAO) has been considered an alternative treatment to prevent embolic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it carries a risk of general anesthesia or esophageal injury if guided by transesophageal echocardiography (TEE).AimsWe aimed to investigate the feasibility and safety of minimal LAAO (MLAAO) using Watchman under fluoroscopy guidance alone in patients with NVAF.MethodsA total of 249 consecutive patients with NVAF who underwent LAAO using the WATCHMAN device were divided into two groups: the Standard LAAO (SLAAO) group and the MLAAO group. Procedural characteristics and follow‐up results were compared between the two groups.ResultsThere was no statistically significant difference in the rate of successful device implantation (p > 0.05). Fluoroscopy time, radiation exposure dose, and contrast medium usage in the MLAAO group were higher than those in the SLAAO group (p < 0.001). The procedure time and hospitalization duration were significantly lower in the MLAAO group than those in the SLAAO group (p < 0.001). The occluder compression ratio, measured with fluoroscopy, was lower than that measured with TEE (17.63 ± 3.75% vs. 21.69 ± 4.26%, p < 0.001). Significant differences were observed between the SLAAO group and the MLAAO group (p < 0.05) in terms of oropharyngeal/esophageal injury, hypotension, and dysphagia. At 3 months after LAAO, the MLAAO group had a higher incidence of residual flow within 1−5 mm compared to the SLAAO group, although the difference was not statistically significant.ConclusionMLAAO guided by fluoroscopy, instead of TEE, without general anesthesia simplifies the operational process and may be considered safe, effective, and feasible, especially for individuals who are unable to tolerate or unwilling to undergo TEE or general anesthesia.

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“…Intracardiac echocardiography (ICE) has increasingly been utilized as a novel imaging modality for guiding LAAC in recent years, which is regarded to be more advantageous over TEE due to the avoidance of general anesthesia. The safety and efficacy of ICE-guided approach have been explored by a number of small studies, [30][31][32] In addition, the fusion imaging (FI) of transesophageal echocardiography and X-ray performed during the procedure is in principle available and in practice by some operators, 33 albeit limited experience and the lack of data showing a clinical benefit of this technology have slowed its advancement.…”

Section: Intraprocedural Imagingmentioning

confidence: 99%

Left atrial appendage closure for stroke prevention in atrial fibrillation patients: A promise that came true

Jiang,

Xiong,

Yin

et al. 2023

Pacing Clinical Electrophis

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Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF), considering the high morbidity and mortality of AF‐related ischemic strokes. With the plausible hypothesis that left atrial appendage is the main source of thrombus in AF patients, left atrial appendage closure (LAAC) has been regarded as a potential substitute to oral anticoagulation in order to meet the unmet needs for stroke prevention, particularly in patients with high bleeding risk. Notable advancements in safety, efficacy, and device innovation have been made in recent years, albeit concerns still remain regarding the insufficient efficacy data, device‐related complications, and the need for procedural optimization. We aim to review current knowledge about LAAC and provide potential future directions for the remaining key issues.

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Intracardiac Echocardiography to Guide Watchman FLX Implantation

Cited by 23 publications

References 13 publications

Left Atrial Appendage Occlusion with Intracardiac Echocardiography and Electroanatomic Mapping

Left Atrial Appendage Occlusion with Intracardiac Echocardiography and Electroanatomic Mapping

A preliminary study of minimal left atrial appendage occlusion using Watchman under the guidance of fluoroscopy

Left atrial appendage closure for stroke prevention in atrial fibrillation patients: A promise that came true

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